Medical Student Projects Funded by the ACCMA Community Health Foundation

Thanks to the generous donations of our members, the ACCMA annually sponsors community health summer research projects for the students of the UCSF/UCB Joint Medical Program (JMP). Our 2023 scholarship recipients, Elizabeth Hoang and Aparna Manocha, outlined the summaries of their project below. Thank you for your continued support of our medical students and the future of medicine. You can donate to the ACCMA Community Health Foundation’s Medical Student Scholarship fund here

The Spectrum of Visual Impairment and Ocular Pathology in a Population Experiencing Homelessness and Housing Insecurity  
Elizabeth Hoang, Brittany Peterson, Carolyn Brandt, Marlon Maus, MD, DrPH, Kieran S. O’Brien, PhD, MPH, Sriranjani Padmanabhan, MD, Matilda F. Chan, MD, PhD  

While constituting 12% of the overall U.S. population, California is home to 30% of the nation’s homeless population and 50% of those without shelter. Homelessness exerts strong negative influences on health, including increased visual morbidity. We chose to study the spectrum of eye disease among the homeless and/or housing insecure (H/HI) population at the Zuckerberg San Francisco General Hospital (ZSFGH), a primary site of safety-net healthcare that provides the full spectrum of ophthalmic care in San Francisco. Data extraction was performed to obtain all visits to the ophthalmology and optometry clinics at the San Francisco Department of Public Health between 01/01/2014 - 02/12/2023 from adults (≥18 years of age) classified as H/HI. Of the 4,741 H/HI patients, 59% were assigned male at birth and 31% were assigned female at birth. The mean age was 58.2 (SD = 14.3) years old. For race and ethnicity, 32% were of Hispanic, Latino/a, or Spanish origin, 27% were Black/African American, and 24% were White. The top three most common medical diagnoses were hypertension (52%), Type 2 diabetes mellitus without complications (33%), and chronic pain (28%). The top three most common ophthalmic diseases were refractive error (97%), mild to moderate nonproliferative diabetic retinopathy without macular edema (67%), and cataract (57%). These prevalences are higher than the general populations. Our results indicate that some of the most prevalent ophthalmic conditions in the H/HI population can result in irreversible vision loss and require close follow-up and chronic care. We hope our study will guide the healthcare team in prioritizing and addressing the most pressing ocular diseases more effectively and equitably among the H/HI population.  

Parent and teen perceptions of conversations about sexual health and relationships 
Aparna Manocha, Martha J. Decker, MHS, DrPH; Abigail Gutmann-Gonzalez, MPH 

Parent-teen communication about sexual health is critical to the development of a child’s physical and emotional well-being. Yet conversation around sex remain difficult for many families due to challenges around limited knowledge, embarrassment, and cultural and social barriers. Teens in rural communities face social, structural, and cultural norms that pose obstacles for youth to receive information about sexual health. These challenges contribute to an increased risk of unintended pregnancy and sexually transmitted infections (STIs), including decreased access to healthcare services, lack of comprehensive sexual health education, and living in areas of high concentrated poverty. This qualitative study explores the perspectives of parents and adolescents in rural areas of Fresno County on talking about sexual health and relationships.  

Parent and teen dyads were individually interviewed in Spanish or English. Thematic analysis was conducted through Dedoose. Subcodes were developed based on themes that emerged from analysis. Overall, most parents are communicating with their teenagers about sex, sexual health, dating and relationships. However, more participants reported discussing dating and relationships than sex as these conversations were reported as stressful. As anticipated, common topics of discussion included abstinence, unplanned pregnancy, contraception, STIs, and dating safety. Results suggest that many parents felt they did not have the right words to discuss these topics as cultural norms and shame had prevented their own parents from having these conversations with them. The most common recommendations mentioned by teenagers were the importance of parents listening better, being more open and less harsh, and increasing communication about these topics. Most parents expressed interest in obtaining more information, with suggestions of more sex education and parent/teen workshops. Our findings can be used to inform future programs and policies related to parent-teen communication.